Providence Health & Services Request Specialist - Utilization Management in Mission Hills, California
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Providence is calling a Request Specialist, (Full Time Day Shift) to Providence Facey Medical Foundation in Mission Hills, CA.
Please upload a current resume reflecting all professional nursing experience.
We are seeking a Request Specialist who will demonstrate competency and knowledge in HMO/EPO/PPO eligibility and benefit coverages. Serve as a liaison between patients, hospitals, health plans, and Facey Medical Foundation and Facey Medical Group. Responsible for verification of eligibility and benefits for managed care members.
In this position you will have the following responsibilities:
Deliver upon the service expectations of both our patients and fellow staff members by listening to their needs; engaging in positive interactions; and following through on promises made in a thoughtful, efficient, timely and courteous manner so that their total outcome is better than expected
Work in a safe manner, adhering to general safety precautions and standards. Report any unsafe conditions to their supervisor and/or the safety hotline
Verify eligibility, benefits, and researches medical criteria for HMO assigned patients and updates the member’s records as necessary
Report discrepancies of copay/benefit between health plan’s source documents and internal Facey system
Ensure requests are submitted timely and accurately prior to entry into the system
Communicate with providers when requests lack information
Report referral counts daily to Request Specialist Lead
Research, reconcile, and update service authorizations on claims research requests. Enter extensions of dates, new authorizations, and/or confirms denials (per Case Manager’s review)
Input retrospective authorizations into various systems
Call on-call physicians for emergency authorizations and inputs into the system real time
Serve as liaison between patients, providers, and the organization regarding benefits and eligibility
Notify patients and providers of routine authorizations or denials by mail and fax
Notify patients and providers of urgent or stat authorizations or denials by phone
Interface with patients directly, and schedules appointments accordingly
Handle phone calls from patients, hospitals and outside providers regarding inquiries on insurance benefits, authorizations, hospital bills and dates of service
Input authorizations and tracks patients with HIV or on dialysis
Assist case managers by gathering necessary information needed for review and assists with outbound calls to patients
Complete required patient notification letters (e.g. extension, carve out, denial, approval letters)
Forward any investigational or experimental requests to the patient’s health plan for review
Attend required/assigned meetings by the supervisor and manager
Required qualifications for this position include:
1 year experience in a clinic, hospital or related health care industry in a managed care environment, or equivalent in education or medical certification in medical field (i.e. nursing, medical billing and coding, or medical admin assisting)
Data entry experience
Knowledge of HMO/EPO/PPO insurance processing, ICD-9 and 10/CPT coding and medical terminology, a plus
Ability to use 10-key calculator by touch or sight
Type 45 wpm
Computer skills (MS Word, Outlook and Excel)
Ability to multi-task and prioritize
Possess excellent customer service and communication skills, answer Customer Service call line calls and data entry, be organized and self-starter
About the organization you will serve:
Facey Medical Group is a multi-specialty medical group with over 160 physicians providing care to the growing population in the North & East regions of Los Angeles & Ventura Counties. Twelve medical clinics, including two urgent care centers and dedicated women's centers, are located across the San Fernando, Santa Clarita and Simi Valleys. The group began as a single medical practice over 90 years ago.
Facey is part of Providence Health & Services, an integrated, not-for-profit 5-state network of hospitals, care centers, medical clinics, affiliated services and educational facilities spanning from California to Alaska.
We offer comprehensive, best-in-class benefits to our caregivers. For more information, visit
As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Patient Services
Location: California-Mission Hills
Req ID: 307906